Provider Demographics
NPI:1235288374
Name:LYNDES, HARRY EVERETT (MD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:EVERETT
Last Name:LYNDES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 N 5TH AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3080
Mailing Address - Country:US
Mailing Address - Phone:360-582-2623
Mailing Address - Fax:360-582-9623
Practice Address - Street 1:777 N 5TH AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3080
Practice Address - Country:US
Practice Address - Phone:360-582-2623
Practice Address - Fax:360-582-9623
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00025097207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1037571Medicaid
WAB18234Medicare UPIN
WA1037571Medicaid